Nursing Prioritization! Help!

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Hi! I am a senior nursing student, graduating this May ?For a simulation assignment, we have to prioritize which patient we will see first. I'm having a really hard time figuring it out. Here's the info:

73 y/o female, total knee replacement 3 days ago; developed small PEs, now on heparin, : smoker x 50 years (1/4 ppd), past Medical History: degenerative joint disease, arthritis, glaucoma

55 y/o man, 129 kg, past Medical History: Hypertension, Hypercholesterolemia, Type 2 Diabetes, resented to ED with chest pain. Now in cardiac cath, primary medical diagnosis: chest pain, : smoker 1.5 ppd x 20 years

65 y/o man, 125 kg, past Medical History: MI (5 years ago), hypercholesterolemia, 40-year smoking hx, Admitted to hospital yesterday with lightheadedness, palpitations, chest discomfort. ECG revealed atrial fibrillation, started on IV diltiazem, denies smoking since heart attack, occasional alcohol use, primary Medical Diagnosis: New onset atrial fibrillation

I'm thinking to check on the older lady first? She has PEs and is on heparin (lots of risks), then the cardiac cath guy (he's just gotten back from a procedure, a fairly low risk procedure, but a procedure none the less - also needs monitoring), and then the a-fib guy last. Another guess I have is do the cardiac cath guy first, then the old lady, then afib?

ANY insight would be so amazingly appreciated!!!

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Specializes in Public Health, TB.

This is all the info you have? Any vitals, mentation of patients, how long ago was the heart cath, when did the diltiazem start and what rate is it at?

And my old stand by for prioritization is who is going to die quickest?

If the patient on heparin is alert and oriented, I would predict that she is relatively stable. If she was confused and a fall risk, I would be more concerned.

For a heart cath, a puncture is made into a femoral or radial artery and if that starts to bleed, a lot of blood can be lost in a very short time.

Atrial fib guy? He is most likely on a monitor, and IV diltiazem has a fairly quick onset and half-life. If the rate had just been recently changed, that would need checking. But if he's been on the same rate with a stable heart rate for 8 hours I would not be concerned. And in my experience, a patient with new onset a. fib might very well be on a heparin drip as well.

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I’d see the cath lab guy first. He is post-procedure, so you need to check that everything is OK and that he is stable. I’d see the new onset a-fib guy next because of the drip. I’d want to confirm his vitals and whether the rate of the drip needs to be changed. I’d see the older lady last. She sounds pretty stable.

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Specializes in Inpatient Psychiatry.

Yeah, I'd see the 55 yo with chest pain s/p cardiac cath.

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Specializes in Family Nurse Practitioner.
On 1/26/2019 at 3:17 PM, 7816fallonm said:

Hi! I am a senior nursing student, graduating this May ?For a simulation assignment, we have to prioritize which patient we will see first. I'm having a really hard time figuring it out. Here's the info:

73 y/o female, total knee replacement 3 days ago; developed small PEs, now on heparin, : smoker x 50 years (1/4 ppd), past Medical History: degenerative joint disease, arthritis, glaucoma

*Stable

On 1/26/2019 at 3:17 PM, 7816fallonm said:

55 y/o man, 129 kg, past Medical History: Hypertension, Hypercholesterolemia, Type 2 Diabetes, resented to ED with chest pain. Now in cardiac cath, primary medical diagnosis: chest pain, : smoker 1.5 ppd x 20 years

* Multiple risk factors (obesity, CAD, DM, smoker) comes in with chest pain and is now getting a procedure where his artery is punctured and a catheter is threaded up to his heart to make sure he doesn't have a narrowing/clot causing a heart attack. Post cath monitoring requires frequent site checks to make sure a hematoma isn't developing and that the extremity has good circulation.

65 y/o man, 125 kg, past Medical History: MI (5 years ago), hypercholesterolemia, 40-year smoking hx, Admitted to hospital yesterday with lightheadedness, palpitations, chest discomfort. ECG revealed atrial fibrillation, started on IV diltiazem, denies smoking since heart attack, occasional alcohol use, primary Medical Diagnosis: New onset atrial fibrillation

*Diagnosed and being treated

I'm thinking to check on the older lady first? She has PEs and is on heparin (lots of risks), then the cardiac cath guy (he's just gotten back from a procedure, a fairly low risk procedure, but a procedure none the less - also needs monitoring), and then the a-fib guy last. Another guess I have is do the cardiac cath guy first, then the old lady, then afib?

ANY insight would be so amazingly appreciated!!!

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cath, afib, 3-day post-op lady

1
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Specializes in anesthesiology.
On 1/29/2019 at 10:09 AM, JKL33 said:

cath, afib, 3-day post-op lady

samesies.

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I'm seeing this a little different from you, I'm reading this as the cardiac cath guy is currently in the lab getting the procedure done.

My thought process:

If that's what it meant, then he's your lowest priority because he's not even there.

The knee replacement lady... I don't see her trying to get out of bed. She has painful joints and isn't seeing well. The heparin should have a side effect of increasing the healing of her incision. She should be stable and safe.

The afib guy, he has a history of MI, and is at risk of MI, while taking a medication contraindicated with recent MIs. Because of his medicine he also needs frequent monitoring of his BP and heart rate (I'm assuming that since RVR isn't specified, that he's at a higher risk of becoming bradycardic, which is an emergency on his medicine).

I'm not as knowledgeable as the actual nurses in here, but I'd go afib -> knee replacement -> cardiac cath when he gets back.

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